able byproduct, have continued. In field trials on nonmechanical methods, need for expensive "turning" was eliminated by placing the compost materials on aeration frames, with high-grade composts being produced in 4 to 7 weeks.

DIAGNOSTIC REAGENTS

Certain diagnostic materials, including antigens and antisera, that were unavailable elsewhere, were produced at the Center. State laboratories thus were able to obtain enteric grouping sera, and other types of reagents when supplies were adequate. Streptococcal antisera were produced for the Department of Defense.

TRAINING

Increasing emphasis was placed on developing a broader communicable disease control training program for all categories of public health workers. A total of 176 courses were attended by 3,747 public health workers, including physicians, nurses, veterinarians, sanitarians, and vector control specialists. Slightly more than half of these courses were presented in the States, or at the seven CDC field training stations.

CONSULTATION AND DEMONSTRATIONS

Demonstration projects were conducted at Kansas City, Kansas, Pueblo, Colorado, and Laredo, Texas, to improve vector control practices by initiating efficient refuse storage, collection, and disposal practices; extending sewer systems to permit elimination of insanitary privies; developing satisfactory methods of industrial waste disposal; eliminating animal shelters or controlling fly breeding within them; and encouraging revision of existing municipal ordinances or adoption of new regulations relating to improved environmental sanitation.

Upon request, special laboratory assistance was rendered to 22 States. Program reviews were made of 4 State health laboratories. Nearly 2,000 items of instructional material including stock cultures, slide mounts, and literature were distributed to public health laboratories in 47 States, 4 Territories, and 41 foreign countries. Over 40,000 specimens were submitted to the Center for reference diagnosis, either for confirmation or because they presented diagnostic difficulties.

Dental Public Health

During the year, the Division of Dental Public Health continued to work toward the development and application of new knowledge to improve the Nation's dental health through: (1) developmental research studies; (2) provision of consultation, technical assistance, and professional guidance to State and local health departments.

DEVELOPMENTAL STUDIES

Ten years of fluoridation of the Grand Rapids, Michigan, water supply has demonstrated the effectiveness, safety, and practicability of this public health measure for reducing dental caries. During the year, 1,085 communities, with an aggregate population of almost 21 million, were fluoridating their water supplies. Topical fluoride programs were also developed in many State and local health departments. Studies of the dental needs of children living in fluoride areas— underway in Cambridge, Maryland, and Gainesville, Florida-will provide age-specific data on children's dental needs, both initially and on a maintenance basis. These studies will also provide opportunity for developing and refining dental public health techniques.

Studies designed to develop realistic indices for measuring the incidence and prevalence of periodontal disease, specifically gingivitis, are continuing. The development of such an index will make possible a better understanding of the characteristics of gingivitis.

Laboratory studies to develop new and improved methods of fluoride analysis, feeding and handling compounds, and of defluoridation methods are being carried out. Projects to test defluoridation procedures developed in the laboratory are continuing in two communities in an effort to develop effective and less expensive means for removing excess fluorides from water supplies.

PROGRAM SERVICES

Consultation and technical services were provided to 20 States on specific dental health projects. These projects were designed to provide new scientific knowledge, to study a particular problem area, or to evaluate local dental health programs.

Division personnel conducted short courses in fluoride analysis for water works operators.

Assistance was provided to four schools of dental hygiene in developing curriculum, and to six State and local health departments in utilizing dental hygienists effectively. Auxiliary personnel, particularly dental hygienists, can be used to extend professional skills and services to a larger number of people.

Another new area of activity centered on the problems associated with the dental needs of the chronically ill. Pilot surveys were begun of the dental needs of the chronically ill patients in two State hospitals.

Division of International Health

The Public Health Service continued to maintain active relationships with the World Health Organization, the Pan American Sanitary Organization, and the agencies of the United States Government

operating health programs abroad. This work is focused in the Division of International Health.

Two significant measures related to international health were effected during the year. One was the removal of the limitation upon the United States contribution to the World Health Organization. The other was the termination of the Foreign Operations Administration as an independent agency, effective July 1, 1955, and the establishment of the International Cooperation Administration within the Department of State.

INTERNATIONAL HEALTH REPRESENTATION

The relationship of the Public Health Service to the World Health Organization and the Pan American Sanitary Organization is maintained through the Department of State in regard to all policy matters and directly with the organizations on all technical matters. Officers of the Service served on official delegations to the XV Pan American Sanitary Conference in Santiago, Chile, the Eighth World Health Assembly in Mexico City and on many WHO expert committees. The Division continued to perform a major role in the preparation for U. S. representation at international health meetings.

In addition members of the Division staff attended and participated in a wide range of meetings on international health matters. In cooperation with the National Citizens Committee for the World Health Organization, the Division arranged for a seminar program on technical subjects for the delegates returning through the United States from the World Health Assembly in Mexico City.

Under operating agreements between the International Cooperation Administration and the Public Health Service, the Division continued to recruit personnel for overseas missions; train professional and technical personnel from foreign countries; provide consultation to the public health personnel connected with FOA programs; and obtain or prepare technical materials for use in the overseas health programs.

At the close of the fiscal year, health programs were receiving ICA assistance in 42 countries, using a total of 400 professional and technical personnel. Of this number, 164 were commissioned officers of the Public Health Service.

A major activity of the Division is the supervision of training programs of foreign health personnel in this country for study or observation. During the year, 771 persons from 68 countries were assisted in 111 fields of study. Major fields were public health administration, health education, clinical or laboratory work, nursing, and sanitation. Participants were placed in 39 schools, 26 clinical centers, and 13 inservice training organizations.

Participants in the program came from:

Western Hemisphere---.

Europe____

Middle East__

Africa.

Far East and Southeast Asia..

203 participants from 22 countries
73 participants from 15 countries
110 participants from 8 countries
17 participants from 7 countries
368 participants from 16 countries

The Division staff assisted in the preparation for and participated in two conferences of health personnel in U. S. overseas missions, WHO regional representatives, and personnel from the Washington offices of ICA and PHS. One was a regional conference held in Panama during July for health workers serving in Latin America; the other a bi-regional conference in New Delhi, India, during February-March for representatives from Near Eastern, South Asian and Pacific areas.

Other services in support of health programs of overseas missions included: development of manuals for technical guidance of the missions on health programs; preparation or procurement of technical information requested by overseas health personnel; development of more suitable standards for insecticides and spray equipment for malaria control; visits by staff members to missions; and assistance in providing information and materials for the use of special consultants to the missions.

Table 1.—Statement of appropriations, authorizations, obligations, and balances for fiscal year 1955

Table 1.-Statement of appropriations authorizations, obligations, and balances for fiscal year 1955-Continued